Clinical Program Director Jobs in Minnesota (NOW HIRING)

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

The clinical pharmacist is responsible for supporting all aspects of pharmacy business segments and working with the pharmacy department to provide hands-on support, consultation, technical and clinical expertise. This includes coordination and evaluation of the clinical and strategic components of the drug management program and representing the pharmacy department at various teams and committees throughout the organization requiring clinical pharmacy expertise. The individual will collaborate closely with Medicaid, Medicare and Commercial associates from the health plan, and the pharmacy benefit manager (PBM), to coordinate activities and program interventions of the health plan. This role plays a critical role in supporting the strategic and operational objectives of the pharmacy department.

Your Responsibilities

• Support the Senior Director of Pharmacy and Pharmacist Business Segment Directors in representing the department on drug management strategies as needed throughout the organization.
• Represent pharmacy department and/or lead clinical pharmacy meetings for drug prior authorizations and other drug management strategies and provide performance analysis on programs and initiatives.
• Provide consultation and clinical expertise internally and externally to departments and committees to support the processes associated with the clinical review of drug prior authorization and appeal requests to ensure appropriate therapy and make recommendations based on clinical data and research.
• Analyze clinical and financial data and policies for all lines of business.
• Partner with business and product analysts to lead non-clinical program implementation, providing the clinical perspective needed to define requirements, set rules, and ensure clinical appropriateness and smooth execution across pharmacy and medical benefits.
• Provide clinical support for state and federal mandates. Maintain currency with clinical practice guidelines and drug pipeline. Partner with pharmacy business segment analyst to identify new utilization management opportunities as well as monitor performance of clinical program initiatives.
• Actively engage with the internal associates in the design and coordination of clinical program elements including drug utilization and benefit management.
• Support Pharmacist Business Segment Directors as needed.
• Other duties as assigned.

Additional Duties and Responsibilities

• May perform responsibilities for drugs covered under the pharmacy and/or the medical benefit.
• May perform pharmacist consultation to support the case management program process.
• May engage in consultation with provider network.
• May assign employee tasks and provide work direction and feedback. Accountable for executing departmental goals and policies.

Required Skills and Experience

• Clear and active Pharmacist license in the state of Minnesota.
• BS degree in Pharmacy or PharmD.
• 2 + years of relevant clinical experience in health plan/prescription benefit management/managed care, specifically medical benefit drug management.
• Excellent verbal and written communication skills.
• Superior analytical, quantitative, and problem-solving skills.
• Strong business acuity.
• Strong collaborative nature.
• Some travel is required in the local market.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer, please review our benefits page.

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.